Healthcare Provider Details

I. General information

NPI: 1104737063
Provider Name (Legal Business Name): MOSHE GOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655A OLD COURT RD STE 1
BALTIMORE MD
21208-3959
US

IV. Provider business mailing address

6422 ELRAY DR APT C
BALTIMORE MD
21209-2945
US

V. Phone/Fax

Practice location:
  • Phone: 410-630-9064
  • Fax:
Mailing address:
  • Phone: 912-596-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35488
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: